Module Two: Funding

Funding a drug checking program

Securing Funding

The first step to starting a drug checking program is securing the necessary funding. Drug checking is a financially intensive intervention; equipment, staff time, training, and lab-based secondary verification testing are all major expenses. Additionally, be sure include funding for technical assistance, implementation support, and training into the budget. Drug checking requires in-depth knowledge and subject matter expertise. Thankfully, many of the major expenses are front-loaded as one-time expenditures during the first year of operation (e.g., the instrument is a one-time purchase). After year one, equipment costs and the need for training should be minimal, and the amount of needed secondary verification testing may decrease. Ongoing costs after year one typically include consumable materials (test strips, alcohol wipes, etc.), staff time, and secondary verification testing for a minimum of 10% of the total volume of samples. There may also be some ongoing training costs, depending on the expansion of the program. See the Sample Drug Checking Program Budget below for a more detailed breakdown of costs.

Generally we don’t recommend trying to stand up a drug checking program on a shoe-string budget, or at the expense of other other critical harm reduction interventions. If there is not sufficient funding for supplies like syringes, naloxone, and safer smoking equipment, those interventions should be prioritized over drug checking. At the same time, drug checking programs can roll out in stages; starting out slowly and expanding as funding becomes more accessible. Programs can start out using immunoassay strips only or mailing samples to a secondary verification lab to get a general idea of the local drug landscape and to begin community engagement around drug checking. These initial steps can help establish the need and demand for drug checking, as well as demonstrate efficacy. Programs can then use this groundwork to advocate for additional funding to expand the program. When budgeting for a point-of-care drug checking program with a spectrometer, we recommend ensuring sufficient funding for at least 1) the drug checking equipment; 2) secondary lab verification; 3) training and technical assistance; and 4) some amount of protected staff time. 

Funding Sources

Funding sources for drug checking are difficult to find, and there is not yet a consistent and predictable avenue for funding. Increasing interest in harm reduction from government funders, coupled with opioid settlement dollars has resulted in a larger amount of money available for harm reduction and harm reduction services than ever before, but funding sources and partnerships specifically for drug checking are still highly varied and inconsistent. Several programs have been funded through the OD2A (Overdose Data to Action) funding stream from the Centers for Disease Control (CDC). State, county and city governments or health departments are now beginning to fund drug checking programs, and programs funded in this way often have the greatest amount of legal protection and support. For example, New York has both city and state funded programs1, and the state of Minnesota has earmarked funding for drug checking programs2, expected to be launched in 2025. Other programs have secured private funding through charitable foundations with an interest in combating the overdose crisis. Private funding can be helpful for regions in which drug checking is not yet explicitly legal and city or state governments aren’t willing to consider funding drug checking due to its legal status. Still, others have partnered with universities to do drug checking as part of a research study3. The equipment, staff time, and secondary testing are paid through research funding, but the service is embedded at and staffed by a local harm reduction program. It is also possible to mix and match funding sources, covering staff-time, equipment costs, and ongoing lab testing from different grants and funding streams. While funding remains a major challenge to the expansion of drug checking, there are also opportunities to be scrappy and creative in securing the needed funding. As drug checking gains momentum, more funding sources are expected to come online to help support drug checking programs. 

Understanding Expectations

For any source of funding, it’s important to have a clear understanding of what the funder’s expectations are and whether they are in line with harm reduction principles and values. For example, a state that wants to fund drug checking at a community-based organization but expects data from drug checking to be shared with local law enforcement is not a good partnership. In this case, data from drug checking programs could be used to directly influence arrests, drug seizures, and raids, contributing to the criminalization of people who use drugs. What’s more, a drug checking program that is even perceived to be providing information to law enforcement will not be patronized by people who use drugs and will ultimately be unsuccessful. Be extra thorough about expectations when partnering with governmental agencies and research institutions and be aware of what strings may be attached to any funding agreements. 

Tips for Funding a Drug Checking Program
  • Give yourself enough time. Getting a drug checking program up and running can take months if not years. Set a realistic timeline with funders and be sure all players understand how long the process may take.
  • The end of a fiscal year (spend down season!) can be a good time to use surplus funds to purchase drug checking equipment. Learn when the federal fiscal year ends as well as state, county, and city fiscal years and start talking to those contacts several months in advance.
  • Combine funding from different pools: harm reduction grants from governments or philanthropy organizations, private grants, and donations. For example, capital expenditures may be tricky for governmental funding, but personnel costs might be easier.
  • For larger institutions, consider searching for OD2A funding.
  • Don’t accept small amounts of funding to carry out an unrealistic amount of work. Don’t commit to anything beyond what the funding will realistically cover. 
  • Be clear with funders about what data is being collected. Data that is required to be reported to funders should be the minimum necessary and should not include any personally identifying information or specific information related to how or where the drug was obtained.
  • Make sure any required deliverables are realistic. Ask other drug checking programs to get a sense for what types of deliverables are feasible. 
  • Carefully assess the power dynamics involved when partnering with a large institution. Are you able to advocate on behalf of your community? Is there a risk that you’ll be trapped by restrictive protocols? Institutional dynamics are something we can cover in the Remedy Alliance Drug Checking Office Hours! (See Continuing Education for more information.)

The unintentional transfer of a compound from one object or place to another.

Needs-based syringe distribution provides people who inject drugs(PWID) access to the number of syringes they need to ensure that a new, sterile syringe is available for each injection. A needs-based approach provides sterile syringes with no restrictions, including no requirement to return used syringes. https://stacks.cdc.gov/view/cdc/112935

A community advisory board (CAB) is a collective group of community members and representatives that provide suggestions, feedback, and directives to an organization. They advocate for the preferences and desires of the community, and help to ensure that the services a program is offering actually meets the community's needs.

Next Distro Definition of Drug Users Unions:

Drug user unions band together for connection, protection, and to change systems that control and punish people who use drugs. They provide opportunities to make changes on social, legal, and health issues that impact drug users. Similar to labor unions, drug user unions work together to solve a problem that members of the group are facing.They can connect you to resources, provide a space to talk about your use, and opportunities for strengthening the rights of people who use drugs like you. Drug user unions recognize the expertise of people who use drugs and put the power in their hands.

https://nextdistro.org/resources-collection/fight-back-drug-user-unions-how-drug-users-are-working-together-for-their-rights

WHP: Drugs of Abuse Testing
https://www.whpm.com/xylazine

DanceSafe Xylazine Test Strips

https://dancesafe.org/xylazine-test-strips/

Godkhindi, P., Nussey, L. & O’Shea, T. “They're causing more harm than good”: a qualitative study exploring racism in harm reduction through the experiences of racialized people who use drugs. Harm Reduct J19, 96 (2022). https://doi.org/10.1186/s12954-022-00672-y

https://harmreductionjournal.biomedcentral.com/articles/10.1186/s12954-022-00672-y

Lopez, A. M., Thomann, M., Dhatt, Z., Ferrera, J., Al-Nassir, M., Ambrose, M., & Sullivan, S. (2022). Understanding racial inequities in the implementation of harm reduction initiatives. American journal of public health, 112(S2), S173-S181.

https://ajph.aphapublications.org/doi/full/10.2105/AJPH.2022.306767

Dasgupta, N., & Figgatt, M. C. (2022). Invited commentary: drug checking for novel insights into the unregulated drug supply. American Journal of Epidemiology, 191(2), 248-252.

McCrae, K., Tobias, S., Grant, C., Lysyshyn, M., Laing, R., Wood, E., & Ti, L. (2020). Assessing the limit of detection of Fourier‐transform infrared spectroscopy and immunoassay strips for fentanyl in a real‐world setting. Drug and alcohol review, 39(1), 98-102.

Gozdzialski, L., Wallace, B., & Hore, D. (2023). Point-of-care community drug checking technologies: an insider look at the scientific principles and practical considerations. Harm Reduction Journal, 20(1), 39.

Brandeis University: Massachusetts Drug Supply Data Stream

https://heller.brandeis.edu/opioid-policy/community-resources/madds/index.html

Washington State Community Drug Checking Network

https://adai.uw.edu/wordpress/wp-content/uploads/THE_DC_Network_Infosheet.pdf

To Combat the Opioid Crisis, Expand Drug Checking Programs
https://www.wired.com/story/to-combat-the-overdose-crisis-expand-drug-checking-programs/

New York State Department of Health Announces Drug Checking Programs

https://www.health.ny.gov/press/releases/2023/2023-10-23_drug_checking_programs.htm

British Columbia Centre on Substance Use: What is Drug Checking

https://drugcheckingbc.ca/what-is-drug-checking/

We Are the Loop: Our History

https://wearetheloop.org/our-history

Nixon Adviser Admits War on Drugs Was Designed to Criminalize Black People

https://eji.org/news/nixon-war-on-drugs-designed-to-criminalize-black-people/

Race and the War on Drugs

https://www.nacdl.org/Content/Race-and-the-War-on-Drugs

Otiashvili D, Mgebrishvili T, Beselia A, Vardanashvili I, Dumchev K, Kiriazova T, Kirtadze I. The impact of the COVID-19 pandemic on illicit drug supply, drug-related behaviour of people who use drugs and provision of drug related services in Georgia: results of a mixed methods prospective cohort study. Harm Reduct J. 2022 Mar 9;19(1):25. doi: 10.1186/s12954-022-00601-z. PMID: 35264181; PMCID: PMC8906357.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8906357/

Emerging Drug Trends and Prevention

https://www.carnevaleassociates.com/our-work/emerging-drug-trends-prevention-issue-brief.html

Ray, B., Korzeniewski, S. J., Mohler, G., Carroll, J. J., Del Pozo, B., Victor, G., ... & Hedden, B. J. (2023). Spatiotemporal analysis exploring the effect of law enforcement drug market disruptions on overdose, Indianapolis, Indiana, 2020–2021. American journal of public health, 113(7), 750-758.

https://ajph.aphapublications.org/doi/10.2105/AJPH.2023.307291

Also referred to as point-of-care drug checking, community based drug checking refers to drug checking that is cited within overdose prevention centers, SSPs, and other harm reduction or community health settings. Compared to nightlife or pop-up drug checking, community based drug checking is more likely to be accessed by people who are structurally vulnerable to the harms of the War on Drugs and may be experiencing homelessness, complex medical concerns, and more chaotic substance use.

Within the context of drug checking, cross-reactivity refers to when a test responds inappropriately to the presence of a secondary compound that is not the primary target substance. For example, the presence of diphenhydramine (the active ingredient in Benadryl) can cause a false-positive result on a fentanyl test strip.

A memorandum of understanding (MOU) is a non-binding agreement between two or more parties that outlines how they will work together. MOUs are also known as letters of intent (LOIs) or memorandums of agreement (MOAs), and sometimes are the first step towards a formal contract.

Immunoassay strips are used to identify the presence or absence of a particular compound. The use specific antibodies to bind to the compound of interest. Immunoassay strips only give a positive or negative answer and do not indicate anything about how much of a particular compound is present. Examples of immunoassay strips commonly used in drug checking include fentanyl test strips, xylazine test strips, and benzodiazepine test strips, although tests are available for many other types of drugs.

The lowest concentration that can be confidently detected by an analytical instrument or technique.

An analytical instrument used to identify different compounds. Infrared spectroscopy uses infrared light to scan a sample, and then measures how the infrared light interacts with the various compounds in the sample.

A local drug supply refers to the localized aspects of drug availability within a specific area, encompassing unique variations in available drugs, adulterants, and distribution methods. These are impacted by regional law enforcement dynamics, community relationships, and targeted policies or interventions specific to that area.

Overdose Data to Action (OD2A) supports jurisdictions in implementing prevention activities and in collecting accurate, comprehensive, and timely data on nonfatal and fatal overdoses and in using those data to enhance programmatic and surveillance efforts. OD2A focuses on understanding and tracking the complex and changing nature of the drug overdose crisis by seamlessly integrating data and prevention strategies.

Following lawsuits against major pharmaceutical companies such as Perdue Pharma, opioid manufacturers and distributers are paying more than $54 billion in restitution for their role in the opioid overdose crisis. Much of this money has or will be given directly to state, county, or city governments but there is little guidance in how the money is to be spent.

An adulterant is a substance added to a drug to increase the bulk or weight of a drug, or to enhance the effects or the delivery of the drug in some way. Examples of common adulterants include xylazine, caffeine, diphenhydramine, and levamisole.

A method of determining the presence or absence of a specific compound using specific chemicals to elicit color changes within a solution. In drug checking, colorimetric analysis, also known as reagent testing, is used to assess for the presence or absence of a specific drug of interest. Results of the test are interpreted based on the observed color changes.